Informing the Clinical Doctorate Dialogue
The final report of the PA Clinical Doctorate Summit is now avalable. Click here to read it.
Statement of the PA Clinical Doctorate Summit
The PA Clinical Doctorate Summit was held on March 25-27 in Atlanta, Georgia. The 45 participants represented a diverse group of practicing PAs, PA educators, PA students, physicians from allopathic and osteopathic medicine, workforce experts, and representatives of physical therapy, nursing, and other professions. The summit participants were charged to address the question, "Is the clinical doctorate appropriate to the profession as an entry-level degree, as a postgraduate degree, or not at all?"
The group proceeded from a set of core values for the PA profession, including the overarching importance of patient care, diversity in all aspects of PA education and practice, and the value of the physician/PA team.
The summit participants came to consensus on the following set of preliminary recommendations.
1. The PA profession endorses the master's degree as the single, entry-level, and terminal degree for the profession.
2. The PA profession opposes the entry-level, PA-specific clinical doctorate.
3. The PA profession supports advanced professional development and education, including the option of non-profession-specific postgraduate doctorates.
4. The PA profession should explore with physician education groups the development of a model for advanced standing for PAs who desire to become physicians (sometimes called a "bridge program.")
The PA Clinical Doctorate Summit, March 25-27, Atlanta, Georgia
In preparation for the summit, participants reviewed a variety of materials, including research summaries of other health professions, commentary from PAEA's Web site, and results of an on-line survey completed by over 5,000 physician assistants, students, and educators.
The summit was financially supported by AAPA and PAEA but the activities of the summit were independent of either organization. The summit was facilitated by Innovation Labs, a consulting firm with a wealth of experience in using creative and interactive activities to produce deliverables from group discussion processes.
At the summit, participants went through a series of activities designed to examine the issues from a variety of perspectives. They heard presentations about the doctor of nursing practice for nurse practitioners and the doctor of science in physician assistant studies by Baylor University and the U.S. Army. The group created a timeline of significant events for the profession and society. It explored scenarios for the future of the PA profession within the context of changes in health care. The group also explored clinical doctorates in other health professions and how those models might apply within the continuum of competence for the PA profession.
Highlights of the summit can be seen at www.innovationlabs.com/clinical_doctorate_summit.
PAEA and AAPA were proud to jointly sponsor this unique summit to investigate the clinical doctorate for PAs and look forward to the rich dialogue that will follow.
Pre-Summit Activities
The main question to be addressed at the summit is:
Is the clinical doctorate appropriate to the profession as an entry-level degree, as a postgraduate degree, or not at all?
How should the PA profession approach the
emerging issue of the clinical doctorate? Many
health professions, including physical therapy,
nursing, audiology, and pharmacy, have
implemented or are making plans to
implement the clinical doctorate as a part of
their profession. These professions have cited
leadership skills, higher pay, and patient
acceptance as reasons why a doctorate education
is needed. The PA community has for the
most part been silent on this issue but
recognizes that this position will not serve
the profession well in the long run. At the
2007 PAEA Annual Education Forum, the
membership passed a motion asking the PAEA
board to establish a mechanism to consider the
clinical doctorate issue and its
implications for the profession.
PAEA
and AAPA partnered to conduct an investigation
to look at the pros and cons of an entry-level
clinical doctorate for the PA profession.
A literature review, survey research, and other
means were used to gather information to inform
discussion of the issue at the March
summit meeting in Atlanta, Georgia.
To facilitate the summit, PAEA retained the consulting firm Innovations Labs (IL), which has a wealth of experience with both for-profit and nonprofit organizations, including the American Medical Association, the Federation of State Medical Boards, NASA, and the U.S. Department of Energy. IL solutions use a creative and interactive process based on individual, small-group, and large-group activities. One feature of IL's work is the creation of a real-time online record, so that nonparticipants can see the discussion more or less as it happened, and the see the process that led to the decisions.
Planning
As a first step in this collaborative process a sponsor group was created to oversee the planning, research, and educational process that will support the final recommendation. This is an independent group, not beholden to the board of either organization, that is charged to cast as wide a net as possible and create a broad-based group of participants with a wide variety of perspectives. Members of this group bring a wealth of knowledge and experience to the process. Sponsor group members are:
Matt Dane Baker, PA-C,
DHSc
Dawn Morton-Rias, EdD, PA-C
Donna
Sewell, MS, PA-C
Patricia Guerra, PA-C,
MPAS
Timi Agar Barwick
Ayeshia Ellington
Pompey
Bob McNellis, MPH, PA
Cheryl
Holmes
Following is a brief summary of the group's activities to date:
- Identified list of perspectives important for inclusion in the doctorate dialogue
- Defined literature search methodology (including search criteria and primary research questions)
- Contracted with research assistant
- Conducted literature review (ongoing)
- Developed stakeholder survey
- Developed and posted bibliography of articles
- Initiated web-based comment section for Doctorate Dialogue (see below)
- Developed continuum of competence model of the profession to guide selection of stakeholders
- Conducted summit
Please click here to view the complete bibliography of full-text articles that the sponsor group has assembled.
Input
Feedback from all stakeholders is
encouraged. Comments submitted will be
distilled and distributed to the summit
participants to help inform the
discussion. Please post your thoughts and
suggestions in the comment box below. PAEA
reserves the right to delete all or part of
comments that it deems to be unprofessional in
tone, personal attacks, or not constructive
contributions to the debate.
Comments
"The PA profession endorses the master's degree as the entry-level and terminal degree for the profession. As of 2012 the degree conferred upon completion of a PA program will be a singular degree entitled the Master of Physician Assistant Practice (MPAP)."
The intent of this recommendation was primarily that there be a single title for the master's degree awarded by PA programs, so that the PA degree would achieve a similar "brand recognition" to that enjoyed by the MBA or the MPH. The particular proposed title of MPAP was endorsed by the summit participants as the best of the examples briefly considered at that time. Further discussion and debate may lead to a different title (for example, one containing the word "medicine").
Please also recognize that the summit was an independent body and that its recommendations are not binding on any institution or organization. The next step is for the recommendations to be acted upon by PAEA, AAPA, and other PA organizations, through their own governance processes. The summit is one step in a longer process of dialogue on this issue, not an endpoint. The summit recommendations will be on the agenda of the 2009 Business Meeting at the PAEA Annual Education Forum in November.
The preliminary recommendations listed at the head of this page indicated "The PA profession endorses the master's degree as the single, entry-level, and terminal degree for the profession."
The final recommendations document indicates "The PA profession endorses the master’s degree as the entry-level and terminal degree for the profession. As of 2012 the degree conferred upon completion of a PA program will be a singular degree entitled the Master of Physician Assistant Practice (MPAP)."
Is the intent to mandate all PA program offering masters degrees with other titles change to the MPAP?
Thanks in advance for your feedback.
That being said, the average NP school master's degree lasts about 2.5 to 3 years, not 27 months straight. The new DNP requires 4 years of post BSN study. I wouldn't say that NP's are better than PA's, or vice versa. I've met great PA's and some rather dumb ones, just as I have met great NP's and borderline retarded ones. It depends on the individual. So please stop generalizing and bashing NP's. If we both stopped to look out ourselves objectively and honestly, we would find many flaws and idiosyncracies within our schooling and professions. One more thought to consider. I have many PA friends who stated that the students in their classes who were RN's first generally did better grade wise, grasped the material faster, and mastered subjects quicker than those who were not RN's. I guess all that buttwiping, vital sign taking, and medication giving does help later on down the road, huh?
I would add, though, that the bridge program was thought of some time ago during the twilight of Dr. Stead's life; I must also add that I am surprised it took this long for us to say that 'we'll look into it'.
This should be the next major step for the profession as a whole, and I don't think we should limit ourselves to primary care. We have to be careful about crafting the language and a public relations campaign that will allow a future including clinical and financial independence, lest we suffer from the same strategies that got us our contrived moniker in the first place.
On that thought, I believe that a name change for the physician assistant should be pursued as a part of a campaign to change the image of our profession if we are to position ourselves as the answer to the health care problem- a crisis that includes, among other things, a shortage of clinicians.
We need to do the following:
1) As with the birth of the profession, go to medical schools that are amenable to PA development and restart the discussion of a roughly 12 to 18 month program to graduate experienced PA’s to be able to sit for medical boards. 2) Make it a top priority to realize this within two years. There should be a pilot class somewhere within three years. Start with those medical schools that have a PA program already in existence. As well, we should also work with the armed forces to develop a program that could be implemented in short time. 3) Change the name of the physician assistant. There are good candidate names that have been bantered about for years. I’m sure by now that we have the resolve to pick a name that truly identifies who we are, and what we do. 4) The AAPA, with the help of other professional organizations, would lead a public relations campaign to communicate the image that we want to portray. This would include all media outlets, not just those publications that are limited to medicine.
In the midst of crisis we have the opportunity to push forward our profession while solving a large problem of health care in our country. Take care not to delay in these endeavors.
Sincerely,
Geoffrey W. Hoffa, PA-C
The clinical doctorate for PA’s already exists (doctor of science in PA studies – DSc – granted by Baylor University in collaboration with the Army). Eventually DSc Army PA’s will enter the civilian market. I suggest that Army DSc PA’s will have a significant competitive edge, all other things being even, but I may be wrong.
I know there are MANY good arguments against the clinical doctorate, and I too have a number of misgivings, but this train has already left the station. It will not be long before a civilian PA program offers some version of the DSc for their graduating class.
2. The committee that just met did not comment strongly enough on their feelings about the doctorate. They only mentioned being against it as an "entry level" PA requirement. I really expected a more black/white commentary - NO or YES. I think we got a maybe. I'm not satisfied with the response. Can't wait to see the full printout.
I get fustrated at the comments that say things like you should have just gone to medical school and may be I should have but I didn't. I didn't because I couldn't afford it. I worked my way through college and I was married and I could not afford any more debt. I also knew that I wanted a family and it seemed cruel to have children and be in residency. I put my family first. I knew that one day I would want to actually see my kids grow up and that I wouldn't be able to do that and have a $200,000 student loan. I think it is a shame that in order to become a physician you have to either just have money or put your family second. Caring mothers and fathers make great PA's and physicians but today's system is discourages them.
I think the clinical doctorate would be very confusing and a waste of time. A bridge program to MD would be amazing and I would do it in a heartbeat. A bridge program would allow smart and compassionate people to become physicians while not having to sacrifice their family. It would also allow for more people to stay in family practice. When you start your career in so much debt you almost have to go in to a specialty just to pay back what you owe. Ideally I believe that you should start with PA's that have at least five years experience and offer a shortened version of medical school as well as shortened residency requirements. For family practice it would be great. Most family practice PA's have the exact same duties as thier covering physician. It just seems like a waste of time to me to start from scratch and go through entire medical school. I don't work in a specialty so I don't know how different a PA's job is from the physician's in a specialty. If they do work out a bridge program I'll be the first to sign up.
The moral of this story is "A horse is a horse of course of course"
That said, I disagree with the concept that a clnical doctorate adds no additional competency. I am familiar with the US Army program and those emergency medicine graduates are outstanding! The structured formal training at the level 1 trauma center gives its students the opportunity to learn in ways that OJT could never provide.
I say... give us a advanced standing track to medical school and clinical doctorate options for specialties.
-Eric
I would support some type of accelerated bridge program (perhaps with a mininum experience requirement) from a MSPAS to an MD. The PA profession has been designed as a dependent practioner. The only situation where a clinical doctorate would make sense is if the PA profession was seeking independence. To me, this defeats the whole purpose of the PA role. To me it all sounds absurd.
I would love to see the study group go in the direction of developing that pathway, rather than further the discussion on the useless doctorate degrees being discussed that do nothing for the clinically practicing PA and merely increase education costs, and enhance the academic PA and those with enhanced salary structures based on degrees obtained.
This is an opportunity for the PAEA and AAPA to do the right thing in spite of any perceived momentum in the direction of the useless PhD, DHSc or similar academic title degree. We don't need any more entry level degree discussion.
Many don't realize that Dr. Stead's most passionate "cause" was not the PA profession. It was reforming MD education. He labored hard to throw out the useless paradigm of current education and move toward a vision that would include PA to MD/DO pathway. Lets move confidently towards really fulfilling Dr. Stead's dream and impact medical education in a meaningful way...PA -->MD/DO pathway. It's time!
I would submit to you that regardless of what "other" professions do in this venue, THE doctorate for the discipline of the PA is an MD or DO degree....and I would encourage the committee to not follow the educational types in our profession, who have a vested interest in this issue, and recommend the MD/DO route for clinical doctorates. Lets really help our profession and go the "right" direction not the wrong one towards higher educational costs for useless distance education doctorates that do nothing for the core profession.
MD/DO, and most PAs had bachelors undergrad. RNs had microbio etc...and then earn their BSN. As much as RNs would not want to hear this fact, undergrad at other universities have more to do with subsequent practice than the nursing courses offered for the BSN.
Most practicing PAs are graduates of an accredited school, an additional two to three years of condensed medical school curriculum. Many NPs worked when enrolled in the NP programs simultaneously. I do not know even the handful of PAs proceeding to work as EMTs, CRNAs, etc during PA school. NPs had 500 hours of nursing requirements.
The PA generalist training had more hours spent in medical training. MD/DO go through 3 residency. PAs are not required but a number of them achieve the specialty training normally to work in a sub/specialty. 40% are trained as generalists by PAs/MD/DO/some PhD, EdD, DHsc. I believe the AAPA leadership is more cognizant than its academia -- there is not a way to compare the three fields, in terms of time and debt as the basis of "equivalency comparisons," and the most similar in terms of post-bacc medical training of the two would be better distinct than public confusion. PAs are NOT incompetent providers, so do not perpetuate ignorance without the facts.
I'm compelled to confess I am proud of the PA profession and osteopathic medicine, and have resigned the "doctor" title after becoming a PA. The pioneer of the profession would be proud. Keep in mind non-academia practicing NPs feel the move toward the doctoral degree was NOT necessary. I will inform you that this issue is being discussed among the AMA, and there are currently many states with this issue on their legal healthcare platform.
NPs proceed to distance the nursing profession from the MD/DO professions which will NOT help nursing professions benefit from the health care team concept recognized by the PA profession.
Many believe that most institutions would welcome the entry level doctorate in order to gain increased revenues. While that may be true to an extent, I can say that it would cause numerous hurdles for most universities.
Most universities have to deal with regional accreditation bodies (SACS, North Central, Middle States, etc.). The move to a doctoral program would require that the vast majority of PA faculty have a doctoral degree. At present, this is by far the minority. In looking at just the programs within the SACS area (of which my institution is accredited by) there are very few doctorally prepared PA faculty.
The only area where a PA will eventually need a doctorate is in the education arena. There are certainly plenty of opportunities available for those individuals to obtain a doctoral degree. Even if the consensus was made to move to the entry level doctoral degree, it would take years to actually prepare the appropriately credentialed faculty to implement such training and satisfy regional accrediting bodies.
The best solution is the one we now have where the master's is the entry level credential of choice. Those wanting a doctoral degree can pursue this post graduate and choose the degree that most suits their personal goals.
Thomas Morris PA-C
Our profession has long recognized a need to serve communities who are traditionally underserved . A related goal is to increase diversity in our profession. I believe an entry level doctorate would have the opposite effect. If it were an issue of guaranteeing better patient care, there would be no debate, but that is not the case being made. Ours is a competence-based profession, not a degree-based one.
I strongly oppose the clinical doctorate for PAs.
Seymour Butts needs to leave the conversation. Obvious bitterness and need for authority, respect, etc blunt your perspective. You have issues. Deal with them somewhere else.
I still stand by my thoughts on NP education. Give me some websites or links or someone's phone number from an educational authority and I'll look it up.
I also still stand by the thought NO Doctorate PA. It has no clinical purpose that I can find. It will only create chaos in our profession and make it harder and harder to serve patients effectively when everyone is worried about how many initials are behind the name. Take care of the patients first.
Continue the conversations. I hope AAPA is paying attention.
As for the first section, there is definitely the need to prove that any degree made should be for the betterment of the PA profession, whether it be a bridge program or a new doctorate all together. If there is a means to produce possible curricula, that would be a favored course of action. As some have already discussed in their postings, it may be seen as though in all of the degree advances, no real advances of teaching has actually been made. To make such accusations on either side of this debate, one should always try and bring forth citations of credible evidence to support their argument. If something like that could be presented in these postings, I would be more than glad to read it, as I have read every posting that everyone has made thus far. Now, if it is seen that through any course of action to make a doctorate program would not truly create a higher level of learning in the program than what is being taught at the levels currently, we should abandon this discussion now.
When discussing what to call PAs, it is almost universal not to call them doctor. With what has been discussed so far, I would definitely agree with this. As far as the alphabet soup goes, I would leave that designation to the PAEA and the other groups or individuals to whom this burden of decision lies. Once again, as stated in the point I made before, it is not our duty to be physicians, but to assist them. If that means that some of us may be able to gain higher degrees such as the doctorate for more medical education, so be it. Let the designations given be appropriate to the amount of knowledge learned.
Now to the possible benefits for those with a doctorate. A certain financial gain could be one of the most cited. Certainly, more time in school correlates almost always to more money spent on the education. Accepting this, it would make sense to have a higher pay. However, all involved must remember the duty of a PA is to assist physicians. As an extended arm, PAs are known to work in areas that lack enough physicians or in areas where patients may not be able to afford the care of a physician and need someone who will not be as expensive for one reason or another. Thus, PAs should not abandon such people, for this will taint the name of this profession. Pay benefits for this reason must be circumstantial, and not universal. There are those who have discussed being autonomous. Once again, the job of a PA is to assist physicians. Many PAs are working far away from the physicians they are working under. However, in most areas, laws have already been placed to compensate this. Now, if the doctorate degree possibly had some training in advance knowledge of drug use or other extended training where there are already some limitations, and then it would be proper to try and gain more autonomy. There are of course other benefits that could be discussed, but there is a limit of space and time to discuss this issue on this post.
Now there is the all important question for those currently serving in the profession: what about me? Definitely those who are already serving should be grandfathered in and not forced to go back to school in order to remain certified. As for the competition of jobs, proper time and experience due to activities such as CME should keep them competitive with those who are new doctorates. In a free market system as ours, there are of course many, many vast layers of how to be able to compete in the job market. The point should be though that with the high demand for medical professionals, especially PAs, the risk of job loss should not too great a concern. However, this is an opinion and I have no way of knowing for certain the consequences. I would like to know about with past advances in degrees how the profession was affected though. From what I can see though, it seems as though there are still certificate, associate, and bachelor PAs still working. Once again, the advance of having doctorate PAs should not force PAs with lower degrees to have to return to school in order to keep their certification.
My goal has been to look at all possible routes and see what is best for me. I have looked at becoming maybe a physician, nurse practitioner, or a physician assistant. As I have stated previously, my ultimate goal is to become a professor and teach future generations. Before then, I would like to get my license and work in a rural area. Having grown up on a farm all my life has been a rewarding experience that I would not give up. Furthermore, a doctorate would be a program that I may like to see but would not be necessary for me to join the profession. I am fine with going out to get my PA masters after I obtain a bachelors degree. In fact, should a doctorate be set in place, it should not be required for students to have to take as their degree in order to practice. As I have stated previously nearly a month ago, I know that I do not know as much as those in the profession and speak humbly. However, in order to salvage this discussion and to bring forth what I understand from everyone else, I have tried to put up this new post as accurate with the knowledge I do have. I thank those who had the patience to read this post.
Todd PA-C: Nowadays a PA degree in US is worth more than MD degree overseas. Those foreign "doctors" are at bottom of priority list when it comes to residency.
There are REALLY not a lot of PAs in the market. Seeing you are not satisfied with the PA profession, apply to medical school.
The more I read the list of perspectives of this debate the more it is an ego thing and not an advancement of the profession. We need to be cautious as opposed to insane. We're focusing on the initials after the name. There is a problem when looking at the various standards of PT education. One study claimed doctoral degree PTs were better and doctoral degree PT were the only "advanced" degree other PTs should earn.
Before that can be done, what needs to be done is educating the public. My personal choice is prob going to complete a DHSc. If I work in academia, I'm confident our practicing PAs over the age of 40 will never be ALARMED about the "need" to move toward alphabet soup titles.
NP's DO get medical training. NPs are trained by Physicians, NPs, and in our program, experienced PAs. The goal of NP programs are to train NPs within the NP scope, not the PA scope. Our training is focused differently...we have already established that. Surgical training is something that could be added if a need presented. It is a technical skill that can be learned by any of us. Nursing seeks to go beyond mere technical training. The roots of nursing began with heavy focus on technical skills over 100 years ago. With much experience under our belt we have transitioned to a perfect balance of evidenced based practice and clinical training. If NP's were as inadequately trained as some of you suggest, they why do patient outcomes negate this?
NP practice and teamlike collaboration are supported by the American College of Physicians. Please read the monologue released February 15, 2008 on their website.
It is not my place to make generalizations about PA education and it surprises me that PA's will make generalizations about nursing and NP programs when they have not been through these programs personally. 50 hours of clinical training, sorry, maybe 30 years ago. These comments continue to misinform your profession and others. This negativity is bad for all, especially the patients.
I have not witnessed my NP colleagues bash PA's, and I suspect it is because we don't feel a threat. We desire to work collaboratively with all healthcare professionals to provide improved access and high quality care to patients. I ask that if you feel a need to speak of our profession in a negative light, do your research first, so that when you speak, you can be confident that you are disseminating accurate information.
Nursing is nursing - no matter what you title it.
Practicing Medicine is quite another thing altogether.
PA's are trained by physicians to work with physicians. Thus, practicing medicine.
Nurse Practitioners are still nurses. NOT trained by physicians and trying wildly to get away from them. This I will never understand.
Go back to Texas in the early 90's and see that the Texas Nursing lobby barnstormed the Texas Medical Association demanding independent rights and full billing privileges. They were laughed out of the building.
At the last minute (literally) the NP's came to the PA's and begged to be put on the legislature for our prescriptive privileges and practice rights. They HAD to accept physician supervision to get those rights.
We need to get to a point where we understand the education of NP's and PA's and differentiate them to the public. NP's excel in many fields but they do not have medical training and more often than not - no surgical training at all - not even suturing.
And, to the NP who has posted. Yes, there are still unregulated NP programs. They are in my state and they call me to precept their students for a measly 50 hours of clinical training. AND THAT IS THEIR ONLY CLINICAL PRIOR TO RECEIVING THEIR MASTERS.
So, the NP education is NOT regulated across the country as PA's are and their clinical skills differ IMMENSELY. Until there is a national clearing house for NP's similar to the NCCPA then we have no comparison in education, testing, knowledge base, etc.
I don't want a doctorate PA degree. I like what I do and my position. My patients respect me because they trust me and the knowledge and skills I put forth to them.
I will say NO the doctorate PA again and again and again. It has to go away. We have to meet the needs of the population and serve them well.
MD/DO, and most PAs had bachelors undergrad. RNs had microbio etc...and then earn their BSN. As much as RNs would not want to hear this fact, undergrad at other universities have more to do with subsequent practice than the nursing courses offered for the BSN.
Most practicing PAs are graduates of an accredited school, an additional two to three years of condensed medical school curriculum. Many NPs worked when enrolled in the NP programs simultaneously. I do not know even the handful of PAs proceeding to work as EMTs, CRNAs, etc during PA school. NPs had 500 hours of nursing requirements.
The PA generalist training had more hours spent in medical training. MD/DO go through 3 residency. PAs are not required but a number of them achieve the specialty training normally to work in a sub/specialty. 40% are trained as generalists by PAs/MD/DO/some PhD, EdD, DHsc. I believe the AAPA leadership is more cognizant than its academia -- there is not a way to compare the three fields, in terms of time and debt as the basis of "equivalency comparisons," and the most similar in terms of post-bacc medical training of the two would be better distinct than public confusion. PAs are NOT incompetent providers, so do not perpetuate ignorance without the facts.
I'm compelled to confess I am proud of the PA profession and osteopathic medicine, and have resigned the "doctor" title after becoming a PA. The pioneer of the profession would be proud. Keep in mind non-academia practicing NPs feel the move toward the doctoral degree was NOT necessary. I will inform you that this issue is being discussed among the AMA, and there are currently many states with this issue on their legal healthcare platform.
NPs proceed to distance the nursing profession from the MD/DO professions which will NOT help nursing professions benefit from the health care team concept recognized by the PA profession.
This "more titles is better mentality" is insane. Case in point I've seen our PA students perform better in terms of the medical knowledge than the medical students, with the right treatments and diagnosis throughout institutions in which I've was a faculty --the concept "more titles is better" is not true.
I would agree the clinical doctorate is more money for the academia. But the costs and time surpass the benefits for health care reform. The clinical doctorate to become an PA will increase access to health care? I think not. Overall the clinical doctorate is a waste of time and funds for the future generation of PAs, and would lead to more confusion within the American public regarding the PA role in the betterment of health care. Those needing to be a "doctor," should go to medical school.
I teach in BSN and MSN programs. The clinical hours have not decreased. Program integrity is not compromised by the faculty shortage. The programs just accept less qualified applicants. You are correct that BSN training is not medical training and to include everthing that is learned in a BSN program would be tedious. Hundreds of undergraduate clinical hours and experience as RN's should not be discounted. RN and NP ROLES are different, but the education builds upon and expands the knowledge and practice already gained as an RN. Undergraduate nursing students learn pharm, nutrition, pathophys, lab interpretation, etc., etc. They even learn about common diagnoses, tests and treatments. As RN's they live and learn more everyday and gain intution that cannot be taught. Like PA's many of them have medical backgrounds (Paramedics, RRT's, etc.).
I did not say that NP's had less clinical hours than PA's. I think the NP programs training is commensurate with the background of the students.
I believe that even with a DNP as the entry level degree, that RN's will still choose this over a MD degree. This is because we believe in the Nursing's philosophy/model of care delivery.
If there are NP specialty programs that are shorter than a Master's degree, then you are referring to a post-masters degree only available to those who already have their Masters. There are several specialty NP tracks. I am an an ANP. This means I have logged my clinical hours primarily in Adult Medicine. If I wanted to become an FNP (family), I could go back for another year and complete a post masters degree. You are correct that the titles of NP's have been confusing. There are 2 National board certifying bodies which result in different credentials. If AANP certified then the the credentials are NP-C, If ANCC certified then the NP's specialty track-BC is used (eg. ANP-BC). This is a change in 2008.
RN's have excellent documented clinical physical examination skills prior to entering NP school. I'm not aware of an NP program in the U.S. that does not include medical examination.
In response to the clinical hours logged. I put 500 as a minimum but am not aware of any NP program that actually do this little. Most are closer to 1000 at the Master's (not Doctorate) level.
I think we need to increase our patients' access to healthcare, AND guide the next generation of careers in medicine and/or Primary Care. Adding the time and debt with a clinical doctorate will not benefit the profession.
"Firstly, NP's do NOT "have a third of the training" as PA's as Allyson, PA-C suggested. The track to become an NP is as follows... A candidate must first earn a Baccalaureate degree in Nursing, take a national licensing exam to become a R.N and have practiced a minimum of 1000 hours as an R.N. Nationally, most graduate candidates have practiced many, many more hours then this. These strong clinical skills and intuition gained while practicing as an R.N., carry forward in NP practice." Until very recently, almost all PA applicants had over two years health care experience, some as RNs, some as MDs in other countries, and from a variety of other health care occupations. Many PA faculty can tell you that all of those students, RN and MD alike, had much to learn from their PA programs. BSN education in the US has recently been characterized by a reduction in clinical hours to about 600 hours on the average, generally due to a shortage of nurse faculty and practice sites. Postgraduate practice patterns for nurses are very variable and frequently do not include medical assessment. Pre-graduate nursing education cannot substitute for medical training.
"To respond to comments by The Whole NP debate, that NP's don't have clinical rotations and that a degree can be obtained in 9 weeks to 2 years with as little as 40 hours of clinical contact, is COMPLETELY FALSE. As stated above, the minimum degree to become an NP is a Master degree which is 2-3 years of intense training, built upon an already strong clinical R.N. background. Several decades ago, NP programs, like PA programs could be obtained at a bachelor level. This is no longer true for NP's. Not only do student NP's log a minimum of 500-1000 clinical hours in grad school (Master level), they have also logged hundreds of clinical hours in their undergraduate R.N. studies and thousands more as practicing R.N.'s." Again, it is true that NP programs have fewer clinical hours than PA programs, as Cooper states. Given that the clinical training in RN programs has become briefer, and experience as an RN is variable, I am not sure that it makes sense to have only 500 hours of clinical training in medicine prior to taking on the title of Doctor, just as I am not sure that it makes sense for PAs with 2000 or more hours! This is the crux of the problem both professions.
"I do agree that NP program curricula needs to be standardized across the nation. This is a major initiative that we are currently working to accomplish."
Indeed this is correct. There are specialty NP programs that are far shorter than Cooper describes still in existence, including those which are primarily non-residential. The myriad of licensure standards for nurse practitioners, along with the various initials used before and after one's name, are not indicative of transparency for the consumer. At least PA-C is a standardized, recognizable nation-wide term like MD or DO.
"Lastly, there are many reasons why entry level NP practice is being converted to a doctoral degree. One of those is because many NP programs have curricula that exceed the usual credit load and duration for a typical master's degree and that NP graduates "are not receiving the appropriate degree for a very complex and demanding academic experience." Many of these programs, require a program of study closer to the curricular expectations for other professional doctoral programs rather than for master's level study."
This is also why many PA Programs are looking at doctoral degrees; 1.5 years of didactic education and fifty 50 hour weeks of clinical training are frequently as much than DPT programs require in both time on task and credit hours, and, as has been pointed out by other commentators, approaching the didactic and clinical length of some MD Programs. Clearly, something must give. University administrators are keen to increase their market share by awarding longer courses of study with higher degrees (and correspondingly higher per credit costs!).
Sometime ago prior to this whole debate, I tried to float the idea of a "medical specialist" degree that was like the "educational specialist" degree (Ed.S) that is in hierarchy, in between a master's of education and a doctoral degree. This degree (the Ed.S) began as a way to recognize post-master's students who did not necessarily want to complete a dissertation as having a higher fund of knowledge. We could grant a master's degree (easily!) after the first didactic year, and then a "medical specialist" (Med. S) degree after the clinical year. That would fulfill additional recognition for an action-packed 27-32 months of education without putting us in the gun sights of physicians while providing transparency to the public. Nurses could do the same (Nur. S).
Unfortunately, many of the health professions have chosen to "short cut" their path to a doctorate degree by perhaps adding limited clinical research to their already established Master's credentialed programs. How valuable is such a degree? In my opinion, it demonstrates just one more example of "degree creep." Pretty soon, the standard degree for anyone will be one of these "short cut" doctoral degrees; we're almost there now.
Why is everyone (those interested in clinical doctorate degrees) so hung up on titles and streamlining their education? Isn't anyone interested in putting the proverbial "blood, sweat, and tears" into their academic doctoral preparation and feeling like they truly accomplished something when all was said and done?
I feel a clinical doctorate is so wrong for both the profession and our patients. PLEASE do not force this on PA's who are truly happy in their roles and are well respected by patients and physicians simply because of the phenomenal job they do.
As a side note, I have been a PA for 25 years. My PA credential was a certificate, after having been awarded 2 prior baccalaureate degrees. Titles and degrees obviously were not my motivators. I have also completed a traditional Master's Degree program in education and plan to pursue a PhD for the world of academia, not clinical medicine. Would I ever consider a clinical doctorate? No way !!
I also agree that NP's and PA's should not be compared as the same because although we practice in similar jobs, we are trained with different patient care models and philosophies and licensed differently. It doesn't make 1 right and the other wrong, rather it makes them unique professions. NP's are designed to be independently licensed health care providers, not to provide care under physician supervision. Lastly, there are many reasons why entry level NP practice is being converted to a doctoral degree. One of those is because many NP programs have "curricula that exceed the usual credit load and duration for a typical master's degree" and that NP graduates "are not receiving the appropriate degree for a very complex and demanding academic experience." Many of these programs, "require a program of study closer to the curricular expectations for other professional doctoral programs rather than for master's level study." http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf I hope that this posting helps you understand NP education better and that you are compelled to further research NP education and practice. NP's and PA's should be working together to promote high quality, accessible patient care in the wake of primary care provider shortages.
Refer to the article by the nursing profession, "DNP Will it create a second-class NP?" This article raises more questions than solutions. This degree inflation mentality is insane. There are several PA colleagues, graduates of the certificate and career (MS/PA-C) programs on the faculty.
My MPAS degree has neither improved academic nor clinical practice. The PA-C has counted for more than the degree. But I believe our AAPA leaders need to regulate the NCCPA's control over the PA profession.
WHY do we need the clinical doctorate? I would argue nursing practice despite the "doctor" NP are not interchangeable at the PA level. To "second-class" our own colleagues? What benefit is this external message of the PA profession within the medical community?
The benefit comes by way of jobs. I think it's nonsense in the first place that degree inflation has happened. Across the board degree inflation has happened. A bachelor's used to mean something no matter what you got it in, now it means you're able to go grad school to get a "real degree". That is in most all areas of academia. It's sad but true. This fight about going to clinical doctorate is sad, but like I stated earlier, I believe it's a matter of time before some force pushes us into it. I say we act now so we can be in more control of the change and not be in a reactionary hustle. Those who have commented on here about the reality of reimbursement, I believe, is the real reason to go to the OPTION of a clinical doctorate. Again, I think it's unnecessary in terms of ability, but I do not want our profession to circle the wagons and simply "protect" our "title" as PA-C's being enough while we're doing equal or superior work to others and getting paid far less because of alphabet soup not being after our name. I think we should be getting paid appropriately for what we do, and bean counters pay us and they see we have a lower level of education then we're probably worth less. Again, sad but true.
As for the bridge idea, why not? There are barriers as a PA. You cannot be a surgeon, period. You cannot do certain things that only MD's are privileged to do and rightly so. Why is it dishonorable to leave and go become an MD? If you're working in primary care or even most subspecialties there would not be a whole lot to gain from going back to school and completing a residency so I doubt there would be a mass exodus and the dissolution of the PA profession.
My thoughts of a bridge program alternative are a bit broader though and this is where, were I talking to an audience, I would expect to have things thrown at me. I see PA schools creeping toward 3 years and there are medical schools scaling down to 3 years, so why not save money and duplication and redundancy of training and have PA's go to medical school for 3 years and have a tract that allows you to work as a PA upon graduation, even award the MD if need be, and not do a residency. Exactly the model the PA curriculum came from, a condensed medical school for MD's being trained to go to WWII. Then, the whole bridge thing would be moot because since you've been to medical school all you have to do is apply for residency. I know this would entail a massive shift and change in training and curriculum and all kinds of headache, but if medical school and PA school become the same amount of time in training, or even similar, I think many would choose medical school and drain applicants from the PA pool. I have interviewed nearly 200 PA school candidates and one of the top reasons for PA school was time of training. If the two become so similar, and they're already nearly equally competitive, why not try for medical school or even both? What does that say about the heart of the profession if people don't really care, just going to the school that lets them in first? I think this is where we very well might be headed.
In the end, I think as things are going a clinical doctorate is bound to happen. The only way I think it will make the most sense is if it allows for an increase in autonomy due to the extra training and if it is a postgraduate program and not entry level. Reimbursement is also a valid reason.
The second concerning the PharmD by Siler looks critically at all aspects for the development of a doctoral degree: http://chronicle.com/free/v52/i46/46b01201.htm
I will point out one quote: "At the turn of the last century, the medical profession had the vision and integrity to ask the Carnegie Foundation for the Advancement of Teaching to study medical education, with the goal of strengthening it. The result was the landmark report of the Flexner Commission, which recommended standardization of medical-school programs. It's time to have a similar external study of clinical doctorates, to establish uniform criteria for them and for the professions that offer them."
If we are going to look at the clinical doctorate it should be from the outside not the inside.
David Carpenter, PA_C
I believe there is no real sense in PhD PAs. In the end, I believe the PhD idea is only an attempt to keep up with the Joneses (NP title) without the financial/reimbursement received by other allied health groups ( audiology, PT) while adding increased cost/time to the current education.
The bridge program, however, makes good common sense for professional growth, increased access to care and increased compensation for similar work.
It is crucial for the PA profession and the MDs/DOs to see this as a win-win situation. It is imperative for PA educational leaders to ensure the time, quality of education, and hours needed to make the bridge from PA to MD would be equal to traditional programs. I would be interested in this bridge only if it is viewed by physician educators as similar to traditional MD education. No one wants to achieve a "shortcut" education. If PA bridge requirements are made equal to traditional MD education, there is no argument to be made for the PA education being a stepping stone. Optimally, the time, cost and quality will be the same as MD education and be viewed as such. I believe it is important for the PA profession to be separate and distinct from the MD profession for long-term viability. This bridge would only allow those who want the next level of education to get what they desire while getting credit for education already received.
I have been in the PA profession going on seven years and hit the glass ceiling of advancement/pay/responsibility/ability for partnership after the first 2 to 3 years of my career. Physicians, on the other hand, seem to continually grow professionally and financially doing similar work. It would be nice to level this playing field by building the bridge.
Please feel free to contact me with any questions, comments or requests to help build the bridge-
A NP degree can be obtained in anywhere from 9 weeks to 2 years and with as few as 40 hours of clinical contact.
PA's will always be broad based sound medical training by physicians to work with physicians and we must point that out.
I've met and worked with some really awesome NPs. But they stay in their realm and usually excel in that area - neonatal ICU, women's health, geriatrics, peds.
PA's have a totally different role. Family Practice, Internal Medicine, surgical specialties, etc.
We should be pointing out our nationally accredited educational process and consistent clinical training requirements and stressing our unique and absolutely wonderful ability to work in medicine.
Skip the doctorate.
Doctorate PA education is NOT necessary. It will exclude MANY from obtaining PA education based on background education, financial ability and TIME. The folks who should be PA's should be able to become PA's in a reasonable and accepted fashion.
I want to be a PA. I don't want my own shingle. I don't want to be called doctor. The work I did 17 years ago was Master's Level but I got a Bachelor's. WHOOOPPEEE. My certificate counts for more. My experience counts for more. The only extra letters I've thought of adding to my education might be PhD in Psychology or a Masters in Social Work so I can move into counseling and have prescriptive rights.
I don't even like the idea of HAVING to get a Master's to continue teaching. I've done the work and experienced life as a PA. I've taken my boards every 6 years. An extra degree isn't going to necessarily make me smarter for my patients. It just shows I could complete an educational process. I'd rather have my patients experience education and better themselves from it.
Moving toward a doctorate PA is a really bad idea. We have the solutions as PAs for a lot of healthcare needs. Don't muddy the waters and make employment less accessible by adding more to the process.
Best wishes to my colleagues who will be leading the process and outcomes.
So we can do what we already do; quite effectively I might add! I don't accept that having clinical doctorates will increase access to care provided by PAs; in fact, I believe it would have the opposite effect; particularly under the constraints defined above.
What about our contributions to the scientific community? Should we support a PA clinical doctorate so we can gain greater acceptance in the academic environment? Well, that's a valid reason, I suppose. But there are other doctoral-degrees we can avail ourselves of, which could provide us with the greater credibility we seek as scientists.
No. There has to be sound reasoning, based on improving the quality of care provided by the individual PA, on adding flexibility for the PA to provide healthcare services, and on enhancing PAs contributions to the advancement of medical care knowledge and practice, before I think I could support a clinical doctorate for PAs.
On the other hand, I wholeheartedly support developing a bridge program for PAs to advance to the level of "medical doctor" if that's their desire; and why not? Why is a PA, who wants to become a doctor in this country, expected to return as a freshman to 4 years of medical school when they have already demonstrated, through their learning and practice, they have mastered many of the same skills that medical schools are trying to teach?
As a profession it is our duty to keep up to date with medical innovations an "advanced" degree wouldn't accomplish. PAs and MD/DO are all trained in the medical model and treat diseases; but they are varied careers and this should be before deciding your career route.
The thought of a bridge cheapens the profession and quite frankly I think more Directors of PA programs nationwide should screen for this type of mentality to prevent individuals infected with this thinking from infiltrating the profession and efforts of so many that have gone before us. What will this bridge do to the future of our profession? It will surely erode it! The PA profession is not a means to an end but an end within itself! If you think that PA school is not equivalent in providing adequate medical care and lacks whatever you desire in the "doctor" title, please do not come into the PA profession. You need to do the years of Med School and complete the years of residency if you desire the MD medical degree and to be called "doctor." Better yet, maybe you should become an NP and try to advance from that profession.
I urge the Directors of the AAPA to take notice of this debate and make a surge of effort to thwart this type of ideology. It is a topic that has been discussed extensively by my colleagues and we have come somewhat to a consensus on this matter. No one should ever be denied the right to extend education and the opportunity to advance. However, if someone is looking for the educational aspect we need to note that the options for advancing educationally have not been circumvented for the PA profession.
There are PA's who have gone on to earn their Ph.D. and even their Clinical Doctorate of PA (Baylor Univ/US Army). I can see one's concern if there were no viable routes for continuing education. But there are viable routes! If it comes down to a "doctor" title for you as a medical provider, then our belief is you need to do medical school AGAIN because obviously your past clinical experience has not persuaded you that being a medical provider is about providing high quality medical care to the patients, not titles.
There are PAs that eventually go on to the entire four years of med school and residency; but that is rare to none because of the high career satisfaction of the PA profession. The new PA student should not be seeking opportunities take the easy route out by a bridge program but I also think you should obtain the medical doctorate if you need to become a MD and to be called "Doctor."
In addition to the proposed post graduate doctoral PA programs I listed, there could also be a couple entry level doctoral PA programs as well.
Similar to the DNP programs, and my proposed post graduate "B" program, an entry level doctoral program (DPA) could be implemented for PA’s who wish to break free of the need for the Physician supervision and become independent PA providers. They could bill independently at 100% a Physician’s fee and could open up their own clinics in underserved areas. They may or may not potentially refer to themselves as “doctors” in the clinical setting. This would also command a higher rate of pay than that of a Master’s level PA or lesser. It would be a great benefit to the nation as well by allowing easier access to quality healthcare in adding many independant PA providers to communities that are lacking traditional Physician's (MD's/DO's) by volume.
Finally like my proposed post graduate bridge "C" programs below there should also be entry level doctoral PA programs for those PA's who wish to continue to practice under the Physician as a midlevel with the benefits that entails but hold a doctoral degree. This could be in the form of a PhD degree (PhD, PA) to accomodate the educational or clinical settings. This type of PA should only refer to themselves as "doctors" in the academic setting, but not in the clinical"." This would however logically command a higher rate of pay as well than that of a PA who holds a Master’s degree or lesser. It will also certainly make them more marketable and competitive for employment.
So in effect, master's level PA's or the lesser would continue to hold the title of Physician Assistant (PA), but any doctoral level PA (other than those PA's who transition by bridge to MD's or DO's) would hold the title of Physician Associates (DPA, or PhD PA).
There is already a doctoral level PA program (DPA) through the military, but I have not researched this and do not know if it is comparible to any of my proposed doctoral PA programs. Also considering it is through the military, I'm not sure that it would be at all equivalent to a civilian doctoral degree.
My wife and I are both products of a 3 year core Master's PA program. Athough there are still PA's practicing who only hold a certificate, AS, or BS in the field, the trend and natural evolution of the PA profession over the past few years has certainly gone to the Master's level.
Unlike our fellow NP's who are in general nurses with advanced clinical training to practice medicine, we PA's are trained from the beginning in the physician mindset (by the medical school model), mostly by Physician's, to practice medicine as are our Physician counterparts. Thus, even before the PA profession progressed to a Master's Degree, it was felt that we were being trained at the Master's level already.
This being said, and now with the advent of the DPT, PharmD, and particularly the DNP programs etc getting up to speed, it would be irresponsible and detrimental in the highest degree to the PA profession if we didn't quickly respond and progress in the same direction. It would have been more prudent for the PA profession to have been in the lead on a doctoral track of some sort already. Now falling behind, it is imperative that we implement the doctoral paths for PA's too.
We do have the potential to gain more academic and professional respect, and better patient perception with a PA doctoral degree, but as Mr. Parish commented above, our NP colleagues seem to be poised to take over the failing primary care system once they are "doctors". This is vitally important because if we as a profession can't compete equally with NP's who will hold their doctorate, in particular for rural health and primary care jobs, then it may even be an issue for the very survival of the PA profession in the future. In turn this could decrease the availability for quality patient care by volume, and cause the nation to suffer as a whole with regards to healthcare. We may even find ourselves working under the supervision of NP's!
Now the solution would not be to provide only one doctoral track for PA's, but rather several and also at least in the beginning maintain the Master's programs as well. The need for this progression has been there for a long time, and my wife and I have discussed this at length since about 2004.
First, the certificate, AS, and BS degrees for PA practice should be phased out if they are not being already and it then be mandated for those programs to advance to the Master's level. Those PA's who are grandfathered in with those degrees already should not be required to hold a Master's degree, but in light of the competitive market, there should be bridge programs available if they want to transition to a PA Master's degree.
Second and most important regarding the doctoral issue, for the PA's that already hold a PA Master's degree, particularly the ones who have graduated from a 3 year PA program, there should be a few bridge programs that they take to gain a doctoral degree if they choose.
There should be a couple post graduate bridge "A" programs within medical schools where the PA can transition to either an MD or DO in primary care. A Master’s level PA should not have to start over as a freshman in a 3 or 4 year medical school since we have a masters in the field of medicine already. As someone commented above, if the Master's PA who transitions to an MD or DO wishes to work in a specialty then they will be required to complete a residency in that field as the Physicians do. They can also apply to a fellowship should they so choose following a residency. This would also be a great benefit to the nation’s quality healthcare as well by adding many MD’s and DO’s into practice through one of these PA bridges.
There could potentially be a post graduate bridge “B” program similar to the DNP programs for PA’s who wish to break free of the need for the Physician supervision and become independent PA providers. They could bill independently at 100% a physician’s fee and could open up their own clinics, provide more quality healthcare to the underserved communities but should not refer to themselves as “doctors”. They could be even called “Physician Associates” or something of the like. This would also command a higher rate of pay than that of a Master’s level PA or lesser.
Finally there should be a couple post graduate bridge "C" programs if they don’t already exist to allow the Master’s PA to transition to a PhD education, or clinical for a PA who wishes to continue to practice under the Physician as a midlevel with the benefits that entails and still hold a doctoral degree. This however logically should command a higher rate of pay as well than that of a PA who holds a Master’s degree or lesser. It will also certainly make them more marketable and competitive for employment.
However this doctoral issue unfolds, it needs to be discussed thoroughly, organized, and quickly addressed and implemented in someway then built upon if we want to grow as a profession and thrive.
The only reason that physical therapists, audiologists, and occupational therapists, moved to doctoral degrees was to break free of the need for a physician referral for services. To gain more autonomy and direct billing. The same appears to be true for our NP colleagues who seem to be poised to take over the failing primary care system once they are "doctors".
So, PA's largely agree that there is nothing to be gained by training at the doctoral level for entry to the profession. It only makes sense if we wish to break free of our dependent practice role.
Let's agree that in 10 years the profession should produce PA doctors who can practice independently and help our NP sisters and brothers improve access to the primary care that will increasingly be needed in this country.
In my view, if we want to be doctors, let's gain the same autonomy as other doctors! Then we can charge medicare at 100% of the physician rate without jumping through the "incident to" whoops.